Percutaneous Injection Of Bone Cement Research Articles

Finite element analysis of vertebroplasty in the osteoporotic T11-L1 vertebral body: Effects of bone cement formulation.

Vertebral compression fractures are one of the most severe clinical consequences of osteoporosis and the most common fragility fracture afflicting 570 and 1070 out of 100,000 men and women worldwide, respectively. Vertebroplasty (VP), a minimally invasive surgical procedure that involves the percutaneous injection of bone cement, is one of the most efficacious methods to stabilise osteoporotic vertebral compression fractures. However, postoperative fracture has been observed in up to 30% of patients following VP. Therefore, this study aims to investigate the effect of different injectable bone cement formulations on the stress distribution within the vertebrae and intervertebral discs due to VP and consequently recommend the optimal cement formulation. To achieve this, a 3D finite element (FE) model of the T11-L1 vertebral body was developed from computed tomography scan data of the spine. Osteoporotic bone was modeled by reducing the Young's modulus by 20% in the cortical bone and 74% in cancellous bone. The FE model was subjected to different physiological movements, such as extension, flexion, bending, and compression. The osteoporotic model caused a reduction in the average von Mises stress compared with the normal model in the T12 cancellous bone and an increment in the average von Mises stress value at the T12 cortical bone. The effects of VP using different formulations of a novel injectable bone cement were modeled by replacing a region of T12 cancellous bone with the materials. Due to the injection of the bone cement at the T12 vertebra, the average von Mises stresses on cancellous bone increased and slightly decreased on the cortical bone under all loading conditions. The novel class of bone cements investigated herein demonstrated an effective restoration of stress distribution to physiological levels within treated vertebrae, which could offer a potential superior alternative for VP surgery as their anti-osteoclastogenic properties could further enhance the appeal of their fracture treatment and may contribute to improved patient recovery and long-term well-being.

Improved pain and quality of life outcomes after percutaneous vertebroplasty for thoraco-lumbar non-osteoprotic compression fractures

Introduction: Vertebroplasty is a minimally invasive technique in which percutaneous injection of bone cement under fluoroscopic guidance Percutaneous vertebroplasty (PVP) has been widely and successfully accepted in the treatment of osteoporotic and neoplastic vertebral compression fractures to control pain refractory to medical treatment. However, using of vertebroplasty as primary line treatment for traumatic, non-osteoporotic compression fractures still not widely accepted and considered a debatable issue.
 Patients and methods: This prospective comparative study was conducted at Neurosurgery department, Mansoura university hospital and Mansoura emergency hospital through the period between January 2015 and March 2016. 20 patients complaining of back pain due to single level thoracolumbar vertebral compression non-osteoprotic fractures were admitted to the study. Patients were divided into two groups 10 patients each, PVP group and conservative group. Outcome were assessed as regard pain improvement using Visual analogue scale VAS and quality of life using short form 36 scale (SF36).
 Results: Ten patients in the PVP group received Vertebroplasty, eight males (80%) and two females (20%) the age ranged from 29 to 62 years with mean age of 44.2+8.3 (mean+SD) years. The conservative group included ten patients seven males (70%) and three females (30%) the age ranged from 31 to 64 years with mean age of 45.1+9.2 (mean+SD) years. The level of injury ranged from D6 to L4. VAS and SF36 results showed significant improvement in post injection results compared to preinjection and to the conservative group
 Conclusion: Percutaneous vertebroplasty is safe and effective procedure to improve pain and quality of life in non osteoprotic patients complaining of traumatic compression fractures of thoraco-lumar region it decreases pain, and provide early ambulation of patients which improve their quality of life without significant morbidity.

Percutaneous consolidation of loosened spine arthrodesis under CT and fluoroscopy guidance by radiologists: a new useful technique.

The objective was to evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for consolidation of loosened posterior arthrodesis performed by radiologists. A single-centre prospective study involving four consecutive patients (three women, one man) suffering from screw loosening (three at the vertebral level, one at the iliac wing level) after Posterior Lumbar Interbody Fusion (PLIF) treatment was done. The average age was 80 years. Surgical treatment was not indicated or not wished for by the patients. Institutional review board approval and informed consent were obtained. Percutaneous consolidation was performed by an interventional radiologist under CT and fluoroscopy guidance. The path of the trocars was made outside loosened screws bilaterally. Follow-up was assessed using the Visual Analog Scale (VAS). In all cases, bone cement was successfully placed around the loosened screw. The mean volume of cement that was injected was 3 ml. No cement leakage was observed. No neurological complication occurred. Using VAS, pain decreased from more than 9/10 preoperatively to less than 2/10 the day after the procedure for all patients (p < 0.05). This study suggests that loosening of spine arthrodesis could be successfully treated by percutaneous injection of bone cement under CT and fluoroscopy guidance. • PLIF is one of the surgical techniques for spinal arthrodesis. • Treatment indications are degenerative disease or instability following trauma, tumour, or infection. • Screw loosening is a frequent complication that can occur after surgery. • Percutaneous facet consolidation under dual guidance seems to be a feasible technique. • The procedure is performed under local anaesthesia using a minimally invasive approach.

Percutaneous Injection of Bone Cement (Cementoplasty) for the Treatment of Symptomatic Subchondral Cysts

Objective: To evaluate percutaneous computed tomography (CT) and fluoroscopy-guided injection of bone cement for the treatment of symptomatic subchondral cysts of the appendicular skeleton. Methods: A single-center prospective study involving 13 consecutive patients with symptomatic subchondral cysts was done (8 women, 5 men). The average age was 67 years. Patients were treated by percutaneous CTguided injection of bone cement into the subchondral cysts. Surgical treatment was not indicated or not wished by the patients who underwent cementoplasty. The lesions were all located in weight-bearing bones, involving the femoral head, femoral condyle, tibial plateau, talus and calcaneus respectively and consisting of subchondral cysts resulting from degenerative lesions or aseptic osteonecrosis. The clinical course of pain was evaluated using the Visual Analog Scale (VAS) before treatment, at one month and three months after treatment, with long-term follow-up from 2 months to 43 months (average follow-up: 22 months). Results: Patient follow-ups in our series show supportive results within 13 patients, 12 patients were satisfied with a long-lasting result after the procedure had been performed, and would recommend the intervention to relatives. The average evaluation of pain was 8/10 (SD: 0.49) before treatment, 3/10 (SD: 0.66) one month after treatment and 1/10 (SD: 0,60) three months after treatment. Our results show a significant decrease of the pain felt by patients between before procedure and one month after the procedure (p=0,002), before procedure and three months after the procedure (p=0,002), one month after the procedure and three months after the procedure (p=0.011). There were no immediate or delayed complications. We observed one asymptomatic para-articular cement leakage at the knee. One patient was not relieved after the procedure and underwent hip surgery. Conclusions: Percutaneous injection of bone cement under CT and fluoroscopy guidance seems to be an effective and safe procedure in the treatment of symptomatic subchondral cysts with a significant decrease of patient’s pain and a mini-invasive approach compared to classical surgical treatment. Thus we recommend that it should be considered as a first choice of treatment for symptomatic subchondral cysts.

Chemical and physical properties of bone cement for vertebroplasty

Vertebral compression fracture is the most common complication of osteoporosis. It may result in persistent severe pain and limited mobility, and significantly impacts the quality of life. Vertebroplasty involves a percutaneous injection of bone cement into the collapsed vertebrae by fluorescent guide. The most commonly used bone cement in percutaneous vertebroplasty is based on the polymerization of methylmethacrylate monomers to polymethylmethacrylate (PMMA) polymers. However, information on the properties of bone cement is mostly published in the biomaterial sciences literature, a source with which the clinical community is generally unfamiliar. This review focuses on the chemistry of bone cement polymerization and the physical properties of PMMA. The effects of altering the portions and contents of monomer liquid and polymer powders on the setting time, polymerization temperature, and compressive strength of the cement are also discussed. This information will allow spine surgeons to manipulate bone cement characteristics for specific clinical applications and improve safety.

Treatment of symptomatic para-articular intraosseous cysts by percutaneous injection of bone cement

To describe the technique and clinical outcome of percutaneous injection of bone cement in the treatment of symptomatic para-articular intraosseous cysts. Five patients (three men, two women; mean age 35years) with painful para-articular intraosseous cysts were treated by percutaneous injection of bone cement under combined fluoroscopic and computed tomography (CT) guidance. The lesions were all located in weight-bearing bones, involving the acetabulum, proximal tibia, distal tibia, talus, and calcaneus, respectively. The average amount of bone cement injected was 2.1ml (range, 0.6-3.5ml). Calcium phosphate cement was used in four cases and acrylic cement in one case. There were no immediate or delayed complications. Full pain relief was obtained between 1 and 4weeks after treatment. All patients made a complete recovery and were pain-free at their last visit. Percutaneous injection of bone cement was a safe and efficient technique in the management of symptomatic para-articular intraosseous cysts in our population.

Surgery for vertebral compression fractures: Understanding vertebroplasty and kyphoplasty

Osteoporosis is a disease of the bones, which leads to an increased risk of fractures and is most common in postmenopausal women. It is estimated that more than 2 million people in England and Wales have osteoporosis and each year there are 180 000 osteoporosis-related symptomatic fractures. Vertebral compression fractures are associated with significant morbidity and the standard treatment for such fractures used to be conservative and symptomatic. However, nowadays vertebroplasty and kyphoplasty have emerged as novel treatment methods and involve percutaneous injection of bone cement into the vertebral body with the aim of stabilizing the vertebral fracture, relieving pain and preventing further loss of vertebral body height.

Experts' agreement on therapy for bone metastases

Experts' agreement on therapy for bone metastases

CT evaluation of local leakage of bone cement after percutaneous kyphoplasty and vertebroplasty

Percutaneous injection of bone cement (acrylic cement) during percutaneous kyphoplasty and vertebroplasty can cause symptomatic or asymptomatic complications due to leakage, extravasation or vascular migration of cement. To investigate and to compare the incidence and site of local leakage or complications of bone cement after percutaneous kyphoplasty and vertebroplasty using bone cement. We retrospectively reviewed 473 cases of percutaneous kyphoplasty or vertebroplasty performed under fluoroscopic guidance. Of the 473 cases, follow-up CT scans that covered the treated bones were available for 83 cases (59 kyphoplasty and 24 vertebroplasty). The rate of local leakage of bone cement was 87.5% (21/24) for percutaneous vertebroplasty and 49.2% (29/59) for kyphoplasty. The most common site of local leakage was perivertebral soft tissue (n=8, 38.1%) for vertebroplasty. The most common site of local leakage was a perivertebral vein (n=7, 24.1%) for kyphoplasty. Two cases of pulmonary cement embolism developed: one case after kyphoplasty and one case after vertebroplasty. Local leakage of bone cement was more common for percutaneous vertebroplasty compared with kyphoplasty (P<0.005). The most common sites of local leakage were perivertebral soft tissue and perivertebral vein.

Vertebroplasty What's New

The first percutaneous injection of bone cement into the spine was performed in 1984 by Dr. H. Deramond (Amiens, France) to treat a 54 year old woman with extreme pain caused by a haemangioma in the second cervical vertebra. Surprisingly, pain relief was complete. After the case was published, indications for percutaneous vertebroplasty quickly expanded to include treatment of chronic back pain caused by metastases and osteoporotic fracture. Since then, many case series (Without randomization) have indicated that vertebroplasty is an effective way to control the pain of vertebral compression fracture caused by osteoporosis (figure 1). Educational Objectives in this presentation: • To show the new randomized double blind multicentre studies • Discuss the utility of vertebroplasty to treat osteoporosis • Identify ideal candidates for Vertebroplasty • Discuss the future of vertebroplasty • In our department we tried since the beginning (1995) of the Vertebroplasty procedure in our hospital to start with a double blind multicentre randomized study. VERTOS I. 1 In this study 34 patients were randomized (18 Vertebroplasty-16 CT (conservative therapy)) recent osteoporotic fracture 6w-6m. with bone marrow oedema on Mirth patients improvement in the vertebroplasty group was fairly consistent so that all the patient of the other group went in crossover after 2 weeks (14/16 from CT to V ).The follow up was 2 weeks and the VAS pain score 8,2 +/–1,21 → 2,1 +/– 1,91(1week) • This small randomized trial showed that vertebroplasty reduced disability and improved quality of life at 2 weeks compared with non-surgical treatment, but the crossovers preclude long-term comparisons. • The results are fairly consistent, and in a new large review of 534 patients, improvement in pain and disability persisted throughout one years of follow-up. Unfortunately we lost the most of the patient during our follow–up. After one Year we could review 124 patient in comparison with the conservative treated patient (128 – 89 p). • The Non-Randomized Review of osteoporotic fracture treatments • (n= 534 → 124 patients with osteoporosis T score: –2,5 equal in both groups(1995-2008) 76% VP/ 24% CMT(128 → 89).Age > 40–85Y.68% Lumbar spine. 32%. Thoracic spine. 89% women / 11 % Men. 475 women 73,4Y – 58.men 78,3y. Average 24d fracture (Type A1–3.1) equal in both groups.1,3 fracture/p with bone oedema. Treatment for Local back pain 6 weeks or less. Bone marrow oedema (MRI).

Vertebroplasty and kyphoplasty: a comparative review of efficacy and adverse events

Vertebroplasty and kyphoplasty have become common surgical techniques for the treatment of vertebral compression fractures. Vertebroplasty involves the percutaneous injection of bone cement into the cancellous bone of a vertebral body with the goals of pain alleviation and preventing further loss of vertebral body height. Kyphoplasty utilizes an inflatable balloon to create a cavity for the cement with the additional potential goals of restoring height and reducing kyphosis. Vertebroplasty and kyphoplasty are effective treatment options for the reduction of pain associated with vertebral body compression fractures. Biomechanical studies demonstrate that kyphoplasty is initially superior for increasing vertebral body height and reducing kyphosis, but these gains are lost with repetitive loading. Complications secondary to extravasation of cement include compression of neural elements and venous embolism. These complications are rare but more common with vertebroplasty. Vertebroplasty and kyphoplasty are both safe and effective procedures for the treatment of vertebral body compression fractures.

Usefulness of percutaneous injection of bone cement into calcaneotibial bone with cancer metastases for pain relief

Usefulness of percutaneous injection of bone cement into calcaneotibial bone with cancer metastases for pain relief

Percutaneous vertebroplasty for compression fracture: analysis of vertebral body volume by CT volumetry

To evaluate the relationships between volume of vertebral bodies with compression fracture (measured by CT volumetry) before percutaneous vertebroplasty, the amount of bone cement injected, and the effect of treatment. We examined 49 consecutive patients, with 104 vertebral body compression fractures, who underwent percutaneous injection of bone cement. Vertebral body volume was measured by CT volumetry. The patient's pain level was assessed using a visual analog scale (VAS) before and after the procedure. Improvement in VAS was defined as the decrease in VAS after the procedure. Relationships between vertebral body volume, the amount of bone cement, and the effect of treatment were evaluated using Pearson's correlation coefficient test. Average vertebral body volume was 26.3 +/- 8.1 cm3; average amount of bone cement was 3.2 +/- 1.1 ml; and average improvement in VAS was 4.9 +/- 2.7. The vertebral body volume was greater if a larger amount of bone cement was injected. There was a significant positive correlation between vertebral body volume and amount of bone cement (r = 0.44; P < 0.0001). However, there was no correlation between vertebral body volume and improvement in VAS, or between amount of bone cement and improvement in VAS. In percutaneous vertebroplasty for vertebral body compression fracture, there is a positive correlation between vertebral body volume and amount of bone cement, but improvement in VAS does not correlate with vertebral body volume or amount of bone cement.

Percutaneous vertebroplasty to treat osteoporotic vertebral body compression fractures

椎体压缩性骨折是骨质疏松最常见的并发症之一.它有相当的发病率,对部分患者造成持续且严重的疼痛.椎体成形术是经皮向骨折塌陷的椎体内注射骨水泥,这种方法已被用来治疗骨质疏松的椎体压缩性骨折,解除患者的疼痛.为介绍该法并探讨安全性和有效性,通过回顾多位作者的报道,我们发现椎体成形术对于疼痛的缓解率可达到67%～100%.短期的并发症主要包括骨水泥的外渗,这不但会增加疼痛,还会散热并压迫脊髓或神经根.合理的选择患者和完善的操作会减低这些并发症,因此,极少需外科减压的手术.但它的长期并发症,如骨水泥-骨接触面的异物反应,骨水泥的老化,由于应力改变而造成相邻椎体骨折的风险增加等尚未完全阐明.因此椎体成形术还需更长时间随访。

Minimally invasive treatments of osteoporotic vertebral compression fractures.

A literature review of experiences with vertebroplasty and kyphoplasty for treating symptomatic, osteoporotic vertebral compression fractures (VCFs). To summarize the advantages and disadvantages of kyphoplasty and vertebroplasty. Osteoporotic VCFs are a leading cause of disability and morbidity in the elderly. The consequences of osteoporotic VCFs (pain and often progressive vertebral collapse with resultant spinal kyphosis) adversely affect quality of life, physical function, mental health, and survival. Vertebroplasty and kyphoplasty are minimally invasive procedures for treating painful fractures. Vertebroplasty entails the percutaneous injection of bone cement into the fractured vertebra in attempts to stabilize the fracture and reduce pain. Kyphoplasty addresses pain and kyphotic deformity by the percutaneous expansion of an inflatable bone tamp to effect fracture reduction before cement deposition in a fractured vertebra. A literature review of surgical techniques, indications, clinical results, and complications for vertebroplasty and kyphoplasty. Studies of vertebroplasty and kyphoplasty have reported excellent pain relief and improved function in most patients with osteoporotic VCFs. Vertebroplasty has the advantage of being relatively quick and inexpensive. Kyphoplasty, while associated with increased cost and surgical time, offers the potential to improve spinal alignment. In addition, by creating an intravertebral cavity, kyphoplasty reduces the risk of extravertebral bone filler extravasation. Vertebroplasty and kyphoplasty are currently used to treat osteoporotic VCFs with successful short-term results. Prospective, randomized studies comparing these procedures to one another and comparing their long-term outcomes to conventional medical management are required to define precise roles of these exciting treatments in the spine physician's armamentarium.

La vertebroplastia percutánea: Técnica y resultados preliminares en 25 procedimientos

Vertebroplasty procedure which involves percutaneous injection of bone cement into a collapsed vertebra using fluoroscopic guidance, has been introduced not only for treatment of osteoporotic patients, who have prolonged long lasting pain following vertebral fracture, but also for osteolytic vertebral compression fractures, to restore its loadbearing capacity and stiffness. Our result suggest that vertebroplasty is associated with pain relief in almost 100% of cases. Proper patient selection and a good technique should minimize complications.

Adjacent vertebral failure after vertebroplasty. A biomechanical investigation.

Vertebroplasty, which is the percutaneous injection of bone cement into vertebral bodies has recently been used to treat painful osteoporotic compression fractures. Early clinical results have been encouraging, but very little is known about the consequences of augmentation with cement for the adjacent, non-augmented level. We therefore measured the overall failure, strength and structural stiffness of paired osteoporotic two-vertebra functional spine units (FSUs). One FSU of each pair was augmented with polymethylmethacrylate bone cement in the caudal vertebra, while the other served as an untreated control. Compared with the controls, the ultimate failure load for FSUs treated by injection of cement was lower. The geometric mean treated/untreated ratio of failure load was 0.81, with 95% confidence limits from 0.70 to 0.92, (p < 0.01). There was no significant difference in overall FSU stiffness. For treated FSUs, there was a trend towards lower failure loads with increased filling with cement (r2 = 0.262, p = 0.13). The current practice of maximum filling with cement to restore the stiffness and strength of a vertebral body may provoke fractures in adjacent, non-augmented vertebrae. Further investigation is required to determine an optimal protocol for augmentation.

Adjacent vertebral failure after vertebroplasty

Vertebroplasty, which is the percutaneous injection of bone cement into vertebral bodies has recently been used to treat painful osteoporotic compression fractures. Early clinical results have been encouraging, but very little is known about the consequences of augmentation with cement for the adjacent, non-augmented level. We therefore measured the overall failure, strength and structural stiffness of paired osteoporotic two-vertebra functional spine units (FSUs). One FSU of each pair was augmented with polymethyl-methacrylate bone cement in the caudal vertebra, while the other served as an untreated control. Compared with the controls, the ultimate failure load for FSUs treated by injection of cement was lower. The geometric mean treated/untreated ratio of failure load was 0.81, with 95% confidence limits from 0.70 to 0.92, (p &lt; 0.01). There was no significant difference in overall FSU stiffness. For treated FSUs, there was a trend towards lower failure loads with increased filling with cement (r2 = 0.262, p = 0.13). The current practice of maximum filling with cement to restore the stiffness and strength of a vertebral body may provoke fractures in adjacent, non-augmented vertebrae. Further investigation is required to determine an optimal protocol for augmentation.

Vertebroplasty: a simple solution to a difficult problem.

Vertebroplasty is the percutaneous injection of bone cement into a symptomatic fractured vertebral body under fluoroscopic guidance. It is a safe and simple outpatient procedure. We discuss patient selection, the techniques, and the results based on our experience and that of our radiology colleagues.

Treatment of painful osteoporotic vertebral fractures with percutaneous vertebroplasty or kyphoplasty.

Vertebral fracture is the most common complication of osteoporosis. It results in significant mortality and morbidity, including prolonged and intractable pain in a minority of patients. Vertebroplasty and kyphoplasty, procedures that involve percutaneous injection of bone cement into a collapsed vertebra, have recently been introduced for treatment of osteoporotic patients who have prolonged pain (several weeks or longer) following vertebral fracture. To determine the details of the procedures and to gather information on their safety and efficacy, we performed a MEDLINE search using the terms 'vertebroplasty' and 'kyphoplasty.' We reviewed reports of these procedures in patients with osteoporosis. We supplemented the articles found with other papers known to the authors and with presentations at national meetings. Randomized trials of vertebroplasty and kyphoplasty have not been reported. Case reports suggest that these procedures are associated with pain relief in 67% to 100% of cases. Short-term complications, mainly the result of extravasation of cement, include increased pain and damage from heat or pressure to the spinal cord or nerve roots. Proper patient selection and good technique should minimize complications, but rarely, decompressive surgery is needed. Long-term benefits have not yet been shown, but potentially include prevention of recurrent pain at the treated level(s) with both procedures, and, with kyphoplasty, reversal of height loss and spinal deformity, an improved level of function, and avoidance of chronic pain and restriction of internal organs. Possible long-term complications, again not fully evaluated, include local acceleration of bone resorption caused by the treatment itself or by foreign-body reaction at the cement-bone interface, and increased risk of fracture in treated or adjacent vertebrae through changes in mechanical forces. Controlled trials are needed to determine both short-term and long-term safety and efficacy of vertebroplasty and kyphoplasty. Both procedures may be useful for osteoporotic patients who have prolonged pain following acute vertebral fracture. Until there is conclusive evidence for efficacy and long-term safety, these procedures should be done only in carefully selected patients, only by experienced operators with appropriate high-quality imaging equipment, and ideally at centers that are participating in controlled trials.